physiology Flashcards
(175 cards)
1
Q
when can breast milk start being produced
A
3rd month
2
Q
what are the systemic effects of oestrogen
A
metabolism of protein/ carbs/ lipids
water and electrolyte balance
blood clotting
3
Q
what is induction of labour
A
attempt made to artificially start labour
amniotomy - artificial rupture of membranes
synthetic IV oxytocin for contractions
4
Q
name 4 physiological changes that prepare the body for the expulsion of the foetus
A
cervix softens
myometrium tone changes
progesterone decreases
oxytocin is produced
5
Q
what occurs in the passive 2nd stage of labour
A
full dilation of cervix before involuntary expulsive contractions
6
Q
describe the mechanism of labour
A
1) descent - down pelvic cavity
2) flexion increase
3) internal rotation of head (45 degree) when hits pelvic floor
4) crowning and extension of head (widest part through)
5) restitution - line head back with shoulders
6) internal rotation of shoulders - fit through pelvic outlet
7) external rotation of head (45) in line with shoulders
8) lateral flexion - guide shoulders out
7
Q
what is a big risk in an induced pregnancy
A
uterine hyperstimulation - by prostaglandins/ oxytocin
fetal monitoring required
8
Q
what is the fetal attitude a measure of
A
how flexed the head is
ideal - chin on chest, suboccipitobregmatic 9.5cm
9
Q
how do you measure fetal well being in a low or high risk baby
A
low - intermittent auscultations of fetal heartbeat (doppler)
high - CTG
10
Q
how long should the passive 2nd stage of labour last
A
1 hour
11
Q
what 3 things can cause an inadequate progression in labour
A
power - contraction - uterine activity
passages - birth canal
passenger - baby - malposition .
12
Q
what kidney marker increases with gestation that may be a marker of pre-eclampsia
A
urea
>600 = neonatal death
13
Q
give examples of decidual changes that occur after ovulation
A
dilation of vessels to increase blood supply
14
Q
what happens to arterial blood reaching the testis
A
mixed with venous blood in a plexus of veins to cool it down
15
Q
what is the role of testosterone in the male reproductive system
A
maintain male sexual function
16
Q
how would you tell if a baby was hypoxic during birth
A
fetal blood sampling from skull
acidic pH
17
Q
what would you do if a pregnant mum past term had a low Bishops score (cervix not dilated/ effaced)
A
vaginal prostaglandin pessarie
cook balloon - dilate and open cervix
18
Q
what drug can be used to encourage contractions in labour
A
oxytocin
19
Q
when should women be seen by their GP after giving birth
A
6 weeks
20
Q
what thyroid changes may occur in pregnancy
A
major iodine transfer to foetus may lead to deficiency
increased T3/4 requirements from liver metabolism
21
Q
what occurs in the active 2nd stage of labour
A
presenting part is visible
expulsive contractions with a fully dilated cervix
active maternal effort
22
Q
what methods are there of assisted/ instrumental delivery
A
forceps
vacuum extraction
23
Q
what are the 2 phases of the 2nd stage of labour
A
passive
active
24
Q
what its the ideal lie/ presentation/ attitude/ position
A
lie - longitudinal
presentation - cephalic
attitude - good flexion
position - LOA, ROA
25
when is mitotic division of oogoium complete
shortly after birth - 5 months
26
when should you be suspicious of a DVT/PE in a pregnant woman
unilateral leg swelling
| SOB or chest pain
27
what does the physiological management of the 3rd stage of labour compromise of
no routine uterotonic drugs / clamping of cord
| maternal effort delivers the placenta (once she feels heaviness in birth canal)
28
what is the role of oestrogen in the female reproductive system
supports secondary female characteristics
negative feedback control of LH, FSH and GnRH
stimulates proliferation of endometrium
29
list some of the targets of testosterone
cns (Aggressive behaviour)
striated muscle
prostate, seminal vesicles, testis, penis
hypothalamus/ anterior pituitary - negative feedback
30
what are oogonium
ovarian stem cells
31
which of CPR or ESR is used as a sign of inflammation/ infection in pregnancy
CRP - stays the same
| ESR raised
32
what is the role of FSH in the female reproductive system
stimulates follicular recruitment and development
33
what factors may effect spermatogenesis
```
testis temperature
loss of blood-testis barrier
immune reactions
reduction on gonadotrophin and androgens
environmental toxins - alcohol, smoking, radiation
drugs
site - trauma, cancer, surgery
```
34
where are sperm matured
epipdydimis
35
how often are vaginal examinations done in the active process of labour
every 4 hours
36
describe the latent first stage of labour
a period during which there are intermittent, often irregular, painful contractions which bring about some cervical effacement and dilation up to 4cm
37
what components make up the bishops score
```
dilation
length of cervix (effacement) - 3,2,1
position - posterior, mid, anterior
consistency - firm, medium, soft
station
```
38
what days of the menstraul cycle does the pre-menstraul phase last
day 26-28
39
what is the anticipated progress rate of the established 1st stage of labour
0.5-1cm per hour
40
when does a spontaneous vaginal birth (SVB) normally occur
37-42 weeks gestation
| foetus presenting by vertex
41
what % of births need assisted/ instrumental delivery
15%
| 20% of first births
42
what does the 2nd stage of labour last between
full cervical dilation - birth of baby
43
why does Alk phosphate increase so much in pregnancy
produced by the placenta
44
what hormone does the corpus lute secrete and why
progesterone - prepares womb for pregnancy
45
what is an amniotomy
artificial rupture of membranes - usually with sharp hook (amniohook)
46
what obstetric emergency is a baby with a transverse lie at risk of
cord prolapse - cord vasospasm and stops pulsating
47
name some indications for induced pregnancies
```
diabetes - big babies
post dates - term + 7 days
maternal health problem
fetal reagans - growth concert, oligohydramnios
social request
pelvic pain
```
48
what is the definition of a secondary post partum haemorrhage
blood loss >500ml from 24 hours post partum to 6 weeks
49
what is the rate of emergency caesarean section in the UK
25%
50
what would you do if a pregnant mum past term had a Bishops score >7 (cervix dilated/ effaced)
amniotomy
51
when is the established 1st stage of labour complete
10cm
| 8 hours primigravida, 5 hours multigravida
52
what is the role of GnRH in the female reproductive system
stimulates LH and FSH secretion from anterior pituitary
53
when does the cardiovascular system return to normal after giving birth
3 months
(volume decreases by 10% 3 days post delivery)
BP by 6 weeks , HR 2 weeks
54
is is negative or positive feedback of oestrogen that leads to the LH sure on day-14 of the menstraul cycle
positive
55
what is the role of GnRH in the male reproductive system
act on anterior pituitary to release LH and FSH
56
what is seminal fluid comprised of
5% bulbourethral gland
30% prostate galnd
60% seminal vesicle
57
where does oedema most affect in pregnancy
fingers
lower limbs
(less able to excrete Na and H20)
58
what things may cause a secondary post partum haemorrhage
retained tissue
endometritis (infection)
tears/ trauma
59
why is glucose in urine common during pregnancy (glycosuria)
state of insulin resistance
| placenta produces a hormone that is anti-insulin
60
what hormone on day 21 of the menstraul cycle is a reliable sign of ovulation
progesterone
61
what score is used clinically to assess the cervix for induction of labour
Bishop's score
| higher the score , more likely induction to be successful
62
what is the role of testosterone in the penis
erective, copulatory and ejactulatory effectiveness
63
what is the increase of blood flow to the kidneys in pregnancy
60-80% by end of 2nd trimester
| microscopic haematuria may be present
64
how much does GFR/ creatinine clearance increase in pregnancy
50%
| also increased protein excretion
65
list situations not to labour
```
obstruction to the birth canal
malpresentation - transverse
medical condition not safe for mum - cardiac, aortic stenosis, retinal detachment
specific previous labour complications
fetal conditions
```
66
give functions of sertori cells
blood-testis barrier
isolate from immune system
physical movement of developing sperm towards lumen
give nutrients to sperm - encourage development
removal of waste (phagocytosis)
removal of excess cytoplasm following cell divisions
67
what is the corpus luteum
what is left from the follicle that released the egg
68
list some breast changes in pregnancy
increased size & vascularity (warm, tense, tender)
increased pigmentation of areola and nipple
secondary areola appears
montgomery tubercules on areola
breast milk form 3rd month
69
what happens to the platelet count in pregnancy
decreases - due to dilution as plasma volume increases
70
what values determine a sub -optimal rate of progression of active labour in primigravid and porous women
primigravida - <0.5cm per hour (2cm in 4 hours)
| porous - <1cm per cour (4cm in 4 hours)
71
how long is a primigravida mother expected to be in the 2nd stage of labour for
3 hours
| 2 hr for multigravida
72
why does a pregnant woman lying flat lead to a 25% reduction in CO
IVC compressed by uterus
73
what days of the menstraul cycle does the secretory phase last
day 14-26
74
what is the role of progesterone in the female reproductive system
maintain secretory endometrium
| negative feedback control of HPO
75
what is the body's increase in oxygen demand whilst pregnant
20%
76
which hormone rises dramatically in the luteal phase of the female menstraul cycle
LH surge
77
which cells produce sperm
germ cells near basement membrane of seminiferous tubules, move into lumen as spermatogenesis takes place
78
when is the 3rd stage of labour prolonged in active management and physiological management
active - 30 mins
| physiological - 60 mins
79
what dilation in cm does the latent 1st stage of labour change to the established stage
4cm
80
what is the optimum temperature for sperm production
32 degrees
81
what determines how many eggs you are born with
mothers health and lifestyle
| genetic background
82
what is the fetal station a measure of
babies head in relation to pelvis
83
how may the foetus lie
longitudinal - vertex/ breach
oblique-
transverse
84
list some things that may cause fetal distress
```
infection - intrauterine distress
uterine hyperstimulation
breathing problems
insufficient placental blood flow
multiple births
cord compression/ prolapse
shoulder dystocia
```
85
what is the normal expected weight gain during pregnancy
10-14 kg
| 2kg 1st triester, 5kg 2 &3
86
what is the role of LH in the male reproductive system
targets androgen production of testosterone to maintain male sexual functions
87
what drug can be given in labour to achieve adequate contractions
IV oxytocin
88
how often is the intermittent foetal HR monitoring undertaken in the 1st and 2nd stage of labour
1st - every 15 mins
2nd - every 5 mins
(usually after every contraction)
same member of staff - continuity
89
what happens to PCO2 and PO2 during pregnancy
PCO2 - decreases as breathing quicker
PO2 - increases - f
ully compensated respiratory alkalosis
90
what 3 things do you use to evaluate the progress of labour
regular contractions
cervical effacement & dilation
descent of the fetal head through the maternal pelvis (station)
91
what hormone co-ordinates the growth of one follicle in the follicular phase of the menstraul cycle
FSH
92
what are the 4 hormones involved in the male reproductive system
GnRH
FSH , LH
testosterone
93
what is the 1st and 2nd most common positions for a baby to be born in
```
occipital anterior (facing floor)
occipital poster (facing roof)
OT/ OL transverse can't be born vagianlly
```
94
what is the name of the final follicle produced in the follicular phase of the menstraul cycle
mature grafiaan follicle
95
what is the main difference between primary and secondary spermatocytes
primary -46 chromosomes
| secondary - 23 chromosomes
96
how many eggs does a woman use in her lifetime
400
97
what is released when a primary oocyte divides
secondary oocyte + polar body
| released at ovulation under hormones
98
what is the role of testosterone in the testis
spermatogenesis
99
why does a physiological anaemia occur in pregnancy
50-70% increase in blood volume but only 40% increase in RBC
100
what is meant by station (-3-3)
measurement of descent of the baby's head
-3-0 - presenting part above ischial spines
0- aligned with ischial spines
0-3 - in the birth canal
101
what does the active management of the 3rd stage of labour compromise of
routine uterotonic drugs
deferred clamping & cutting of cord
controlled cord traction after signs of separation form the placenta
102
how many mitosis and meiosis processes occur in females to produce an egg
1 mitosis - oogonium > primary oocyte
meiosis 1 - primary oocyte > secondary oocyte + polar body
meiosis 2 - secondary oocyte > mature ovum + polar body
103
what happens to the WCC in pregnancy
increase
| baby is a foreign body
104
What cardiovascular features increase during pregnancy
```
circulating blood volume
increased blood flow
increased CO (40%)
increased stroke volume
Increase heart rate
O2 consumption
```
105
do asthmatic ladies struggle in pregnancy
no - progesterone causes bronchodilation
| labour produces indogenous steroids
106
what is the leading cause of maternal death in the UK
maternal sepsis
107
what is the definition of a primary post party haemorrhage
blood loss >500ml within 24 hours from delivery
108
what is the average number of eggs at birth
2, 000, 000
109
what cells release oestrogen
granulosa cells
110
what happens to creatinine and urea levels in pregnancy
decrease - GFR increases so waste products are excreted quicker
111
what cells to oogonium divide into
primary oocytes
112
how much more times likely is thromboembolic disease is pregnancy/ post partum
6-10x
113
list some of the targets of oestrogen
```
cervix, uterus, fallopian tube
mammaroy gland
fat distribution
Bone - matures turnover
anterior pituitary, hypothalamus
```
114
what cells form the blood-testis barrier
sertoli cells
| no blood contact - capillaries provide O2
115
why does the myometrium tone change to prepare for expulsion of the baby
allow for co-ordinated contractions
116
how many sperm are there per ml of ejaculate
20-100 million
117
how long are sperm matured for
3 months
118
what are increased risks in caesarean sections compared to vaginal births
```
infection
bleeding
visceral injury
VTE
(lower risk of perineal injury)
```
119
how many semiferouh tubules make up the testis
300-900million
120
what 5 hormones are involved in the female reproductive system
GnRH
FSH , LH - gonadotrophins
progesterone, oestrogen
121
what is puerperal psychosis
rare but serious psychotic illness - need in patient care
| more common in women with a personal/ family history of affective disorder, bipolar disorder or psychosis
122
what should you assess the liquor for once the membranes have ruptured in pregnancy
colour
smell
volume
123
on a cardiotocograhy (CTG) scan what would you expect to see during contractions
accelerations in heart rate
| if decelerations/ flat lines = fetal distress
124
what hormone makes the endometrium undergo decidual changes after ovulation
progesterone
125
what 4Ts can cause a post partum haemorrhage
tone - pelvic
tissue - placenta
thrombin - clotting problems
trauma - tears
126
how would you measure the foetal heart rate intermittently and continuously
intermittent - doppler, pinnards
| continuous - CTG (cardiotograph)
127
what does the cervix do to prepare for labour
softens
| changes from firm and posterior with a supportive role to anterior / paper thin birth canal
128
why do pregnant women get pink hands and feet
drop in total peripheral vascular resistance
129
when does the secondary oocyte complete its 2nd meiotic division
when it is fertilised by the sperm to form mature ovum and 2nd polar body
130
describe the established 1st stage of labour
regular, painful contractions that result in progressive effacement and cervical dilation from 4cm -10cm
131
why does heartburn/ reflux commonly occur in pregnancy
hormones relaxed stomach sphincter
| bump
132
name 3 possible complications in the 3rd stage of labour
retained placenta
post partum haemorrhage
Tears
133
what is cervical effacement
cervix becomes soft and thin
134
what is the role of LH in the female reproductive system
maintain dominant follicle
induce follicular maturation and ovulation
stimulate corpus luteum until fertilisation takes place
135
how do sperm travel form the epididymis to the urethra
vas deferens
136
what is the role of FSH in the male reproductive system
stimulates sperm production
137
what happens to FSH levels once the egg has been released
drop - follicle no longer needs to grow
138
what 2 things help to keep the testis at 32 degrees
- pampiniform plexus of veins mixing with arterial blood
| - testes are outside the body
139
what hormone causes the egg to be released in the female menstraul cycle
LH surge
140
what days of the menstraul cycle does the menstraul phase last
day 1-4
141
what should be taken in the 1st trimester to reduce the chances of neural tube defects
folate acid
142
what is seen in cephalopelvic disproportion (CPD)
fetal head is in correct position for labour but is too large to negotiate the maternal pelvis and be born
quite rare
143
how long does sperm production take and how long for transport to epididymis
production - 60-75 days
transport - 10-14 days
3 month cycle
144
what drugs may affect spermatogenesis
anabolic steroids
anti-hypertensive
anti depressant
145
how would you assess the engagement, station, cervical effacement and dilation during labour
vaginal examination
146
what days of the menstraul cycle does the proliferative phase last
day 4-14
147
what hormone thickens the lining of the womb whilst the follicle is growing
oestrogen
148
how many fully formed sperm does 1 spermatogonium divide into
512
149
what is the site of sperm production
seminiferous tubule
150
where do the autocrine & paracrine signals that imitate labour come from
maternal, foetal, placental
151
what 2 hormones are higher during the follicular phase of the menstraul cycle than they luteal phase
FSH, LH
152
what happens to haemoglobin during pregnancy
decreases
| RBC and volume increase > relative
153
what percentage of women develop oedema in pregnancy
80%
154
what percentage of pregnancies need induce
20% -1 in 5
155
what cells produce testosterone
laidig cells surrounding testis
156
what are the 2 phases of stage 1 of labour
latent 1st stage
| extablished 1sts stage
157
how much do a pregnant ladies iron and folate requirements increase in pregnancy
iron - 2-3x
| folate - 10-20x
158
how is pregnancy SOB the opposite of pathological
gets better with activity
159
what type of feedback in the female hypothalamic-ovarian axis should be altered in IVF
negative feedback of oestrogen
| increase fertility
160
define labour
the process in which the foetus, placenta and membranes are expelled via the birth canal
161
what if the biggest factor to affect fertility
age - rapidly declines after 35
162
when is fatigue best and worst in pregnancy
bad early
best 2nd trimerster
worst in 3rd trimester
163
what happens to the corpus lute if no pregnancy occurs
degenerates to corpus albicans
164
how often should the contractions be in labour
3/4 : 10 minutes
lasting approx 40-60s
moderate to strong in strength
165
what chemicals cause the increase in HR and BP during labour
catecholamines
166
what is the baby blues
1-3 days post natal mood drop - due to hormonal changes
| doesn't need treatment
167
where do uterine contractions start in labour
fundus of the uterus - move down and across
168
how far must the cervix be dilated before assisted/ instrumental delivery is offered
10cm
169
what drug is given to treat thromboembolic disease in pregnant women
LMW heparin
170
how many sperm are produced each day
30 million
171
where is progesterone released from
corpus luteum
172
what mechanical changes occur during pregnancy
changed shape of spine
| relaxin hormone relexis joints like the pubic symphis to give space
173
what does the 3rd stage of labour last between
birth of baby > expulsion of placenta/ membranes
174
when is emergency caesarean section essential
obstructed labour
| fetal distress before cervix is fully dilated
175
how many days past term would a mother get induced
7 days
| risk of still birth
